Individual
THOMAS FREDERICK MICKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 SILVER LAKE RD NW, SUITE 110, NEW BRIGHTON, MN 55112-1786
(651) 628-9566
Mailing address
1900 SILVER LAKE RD NW, SUITE 110, NEW BRIGHTON, MN 55112-1786
(651) 628-9566
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
30490
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
338380600
—
MN
Enumeration date
10/05/2006
Last updated
12/30/2013
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